Loading...
HomeMy WebLinkAbout0024 MEADOW FARM ROAD - Health 24 Meadow Farm Road Centerville A= 189-118-007 s SMEAD w I No. 2-153LOR UPC 12534 smead.cnm • Made in USA c �J �Za 1yz' rON`'J fidEX USED sl"I PR6DUC(JNE �) M T S TW SR PR Saxcwo RE4UIRE"s $p � 1AIVYWWWODGRAKOW W�-Oo-7 - j yr No. BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion for Vell Con0ruction Permit Application is hereby made for a permit t0fonstruct Alter or Repair ( )an individual Well at: ----------------------- Location Address Assessors Map and Parcel ---------------------------------------------------------------- Owner Address �_�= _ _ll_r. -ell ...............------------------------------------------------------------------------------- Installer - Driller Address Type of Building Dwelling Other - Type of Building-------------------------------- No. of Persons------------------------------_____--______ Type of Well ------------------ Capacity-------------------- - -- -- ---— — Purpose of Well---- '0 Agreement: The undersigned agrees to install the aforeclescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed--- ------ ---------- Application Approved By— -------------- ate Application Disapproved for the following reasons: ----------------------------------------------------------------------------------- Permit No. --1\L2-00 -7 0 Issued date r date - -------- ---------------- - -------------- - -------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the lnpvidual We)l Const:ruc�y ed Wl',-'Altered or Repaired by4 -----------;44�L //-------et'-)' /17 t --f------------------------------------------------------------------------- Installe at------a--K— _a_,_ -------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well P t tion ZI-r e Regulation as described in the application for Well Construction Permit No Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------------------- Inspector-------------------------------------------------------------------------- BOARD OF HEALTH F, TOWN OF BARNSTABLE Yell Con0ruct ion Permit No. _11=--- dv 6 Fee ------ Permission is hereby ranted-- �— nJ �! -! �� ��!----------------------- to Construct (V), Alter (/'), or Repair ( ) an Individual Well at: No. -- �' ''� �E? L - ��!%2--/Z ------------------------------------- I Street Ias shown on the application for a Well Construction Permit No. ------------------------------------------------------------------------- Dated----- ----- -- ----- -------------- --- - ----------------------------------- - ... ..- - Board of Health DATE----�--------�-d�--------------------- Vv y No."------ ---�` Fee- ---`----------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for WrILCon5tructionPermit Application is hereby made for a permit to,Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel S Owneer �`} Address Installer — Driller Address _ f Type of Building / Dwelling _rr,_t � f ---------------------- Other - Type of Building--------------------------------- No. of Persons----------------------------— -- Type of Well- -Ll- Y�—--------------------___ - Capacity-------------------— - - - - --- - Purpose of Well-----/� f �� -- - -- -- - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed -' -'�---------- -- ------ --- dat Application Approved By---- ) '' - ---- - — -— --� -7 -- ate Application Disapproved for the following reasons:------------------------_---------------------------_--------_---_---_------ ------------- -- -- - - - ------- date I Permit No. --1NJ-20o �'OL�--------- -- - Issued— ?-------------------- — --- --- ---------- at ------------------------------------------------------------------------ -------- --------------------- t BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the In ividual Well Constructed ({"), Altered ( ), or Repaired ( ) b -' - rA.z 1f,1 � -�� ��-f�/1 / -I---------------------------------------------------- - ..----------- Installer at----- .� , /�ni_�./ f --- ------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We11 Prote tion Regulation as described in the application for Well Construction Permit No.�6e-�-L_o-7-_6ADated--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------—------------------------- - - Inspector--- - - ------------------------------------ i_ - -- -- _-��_���,--- _---= r�x-,_s----------------r__ ------ _--__---___-_----- -! Approved Pool Code Barrier with Self Latching Gate(s) .74 23 h. 11 CD gin. 3" fl.. ` ~ LOT Q 4.45-40,0 5.I=_ SS 10)ft. 04 a� o f U + I �s' Lot 2 + Plan Book 558 �jq Page 78 ' Y V Dartmouth Pools & Spas Inc. Designed by: 880 Mt. Pleasant St Phone: 508-998-7100 Dan Cosby Designed Sargent Family New Bedford Ma 02745 Fax: 508-998-2307 3/3/2016 for: G 4p�3, -}- 4 Approved Pool Code Barrier with Self Latching Gate(s) T=2a-I3 N � 227 417.n CID ^ \ 0) CA 23 ft. �. LOT 2 n / - + Qe to / Lot 2 1 Plan Book 558 Page 78 Dartmouth Pools & Spas Inc. Designed by: 880 Mt. Pleasant St Phone: 508-998-7100 Dan Cosby Designed Sargent Family New Bedford Ma 02745 Fax: 508-998-2307 2/18/2016 for: ul08 15 10:49p p.1 Commonwealth of Massachusetts oq - ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information Is Centerville MA 02632 7-7-15 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms sv° Ian 1 ,ll 1r, S on the computer, use only the tab 1. Inspector: key to move your cursor-do not James D.Sears use the return Name of Inspector key. CapewideEnterprises,LLC r� Company Name 153 Commercial Street Company Address Mashpee _ MA _ 02649 Cityrrown v State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification i certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection, The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ,45 nspectors signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner j and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. o� LS ns 3/13 Title,5 Official tnspectim Fenn.Subsurface Sewage Disposal System•Pape 1 nr 17� i Jul 08 15 10:50p p 2 Commonwealth of Massachusetts Title 5 Official Inspection Form 'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is MA 02632 7-7-15 required for every Centerville page. Cityffown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1600 Gal. Tank D Box and four 500 gal. chambers. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. j Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years oJd' or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available_ j ❑ Y ❑ N ❑ Na(Explain below): f 1 I rri I t5ins-3113 Tine 6 Official inspection Form:Subsurface Sawage Disposal Syslem•Page 2 of 17 I Jul 08 15 10:50p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 s ` Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owners Name information is Centerville MA 02632 7-7-15 required for every page. Citylrown State Zip Code Date of Inspection S. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpslalarms are repaired. B) System Conditionally Passes (cont): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipes) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ElY ElN ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: { ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Heakh determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/73 Title 5 Of6aal bispeclion Form:Subsurface Sewage Disposal system-Page 3 of 17 1 Jul 08 15 10:50p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is MA 02632 7-7-15 required for every CenterviNe page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Q The system has a septic tank and SAS and the SAS is less than 100 fleet but 50 feet or more from a private water supply well". Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: 1 You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in sompod is less than 6" below invert or available volume is less j than %day flow F4C'11ix-16C t5ins•3113 ,Title 5 Official Inspecfton Forth:Subsurface Sewage Disposal System•Page 4 of 17 Jul08 1510:51p p 5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner owner's Name information is required for every Centerville MA 02632 7-7-45 page. Cityrrown state Zip Code Date or Inspection B. Certification (cont.) Yes No El Required pumping more than 4 times in the last year NOT due to clogged or ® obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply_ ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well- ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet tut greater than 50 feet from a private water supply well with no acceptable water quality analysis. [Phis system passes if the well water analysis, performed at a DEP certified laboratory,for fecal col'rform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system faits. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 1 E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. I Yes No f ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply j El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. i i t5ins-3113 Tide 5 official Inspectim Form:Subsurface Sewage Disposal System•Page 5 or 17 i itz i i t Jul 08 15 10:51 p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name informations required for every Gen tervifle MA 02632 7-7-15 page. . City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ 0 Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CUR 15.302(5)j D. System Information i Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 i 15ins•303 Title 5 Official Inspection Form:Subsurfaw Sewage Disposal System•Page 6 of 17 I I I i Jul 08 1510:51 p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information required for every Centerville MA 02632 7-7-15 page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and four 500 gal. chamberl. Number of current residents: 0 I Does residence have a garbage grinder? El Yes No Is laundry on a separate sewage system? (Include laundry system inspection. Yes ® No information in this report_) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2013-�45,0o0Gals g ( y g (gp ))' 2014-25,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date i Commercial/Industrial Flow Conditions: II Type of Establishment: Design flow(based on 310 CMR 15.203): I Gallons per day(gpd) Basis of design flow(seats/personslsq.ft, etc.): Grease trap present? ❑ Yes ❑ No industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 15ins•3113 Title 5 Official Inspection Form:Subsurfaoe Sewage Disoosel Syslem-Page 7 of 17 . �I Jul08 15 10:52p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is Centerville MA 02632 7-7-15 required for every page. CitylTown Slate Zip Code Date of Inspection D. System Information (cont.) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: NA Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): tsins-3M3 Title 5 Official Inspedion Form:Subsurface Sewage Disposal Spterrt•Page B of 17 I Jul08 1510:52p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is CentervilFe MA 02632 7-7-15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer (locate on site plan): Depth belowgrade: feet i Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.)-. Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No j i Dimensions: 1500 Gal. Precast H-10 3„ Sludge depth: - 151ns-3l13 Title 5 Official Inspoc ion Form:Subsurface Sewage Disposal System-Page 9 or 17 f If Jul 08 1510:52p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owners Name information is Centerville required for every AAA 02632 7-7-15 page_ City/Town state Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness I Oil Distance from top of scum to top of outlet tee or baffle 8' — Distance from bottom of scum to bottom of outlet tee or baffle 18 --- How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank at working level. Tank and covers at 1'below grade. In and outlet Tees. No sign of leak age or over loading. I Grease Trap (locate on site plan): Depth below grade; feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle j Distance from bottom of scum to bottom of outlet tee or baffle I Date of last pumping: Dale t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pege 10 Of 17 f it Jul 08 15 10:53p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is required for every Centerville MA 02632 7-7-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc-).- Tight or Holding Tank(tank must be pumped of time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons pet day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): I i i i Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No ! j i i 15ins-3113 _ - Title 5 Official Inspection Form:Subsurface Sewage DiSposal System•Page 11 of 77 i Jul08 1510:53p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property AOdress Dorothy Savarese Owner Owner's Name information required for every Centerville MA 02632 7-7-15 page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is WxIT-1' below grade. Box is clean and solid w12 lines out_ No sign of over loading or j solid carry over. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No" Alarms in working order. ❑ Yes ❑ No" Comments (note condition of pump chamber,condition of pumps and appurtenances, etc.): i I i I� "If pumps or alarms are not in working order, system is a conditional pass. i Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: i i i t5ins•3)13 Me 5 Official Inspeclicn Form:Subsurface Sewage Disposal System•Page 12 of 17 I i Jul08 15 10:53p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property ACCress Dorothy Savarese Owner Owner's Name information is required for every Centerville MA 02632 7-7-15 page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number: 4 leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc_): Leaching is four 500 Gal. dry well chambers w14' stone. Chambers are 40" below grade. Chambers are dry, wall's clean like new. i i Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration I Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool i Materials of construction 1 9 Indication of groundwater inflow ❑ Yes ❑ No 15in3-3H 3 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 or 17 i I Jul 08 1510:54p p.14 Commonwealth of Massachusetts - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is required for every Centerville MA 02632 7-7-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t - t 1 Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): E i I I { i I (I i L Title 5 Official knspecticn Form:Su Swage Subsurface Sage Disposal System-Page 14 Of 17 i Jul 08 15 10:54p p.15 Commonwealth of Massachusetts ki ir"t-6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Meadow Farm Road Property Addfess Dorothy Savarese Owner Owners Name -- information is required for every Centerville MA 02632 page. CityrTown - Date 6 State Zip Code Date of Inspection D. System information (cant.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below i i 8 / =.3 :Z -6 DELk, 3 zo A •3 =.33 -� g � 0 l i o i I I O - i 15ins-311a 7r6e 5 Official fn PDcbon Form SuDsAwfaW Sewage OsQcsal System-Pane:5 0117 I( f t Jul 08 15 10:54p p.16 Commonwealth of Massachusetts 7 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is required for every Centerviire MA 02632 7-7-15 page_ City/7own state Zip Code Date of Inspection D. System Information (cont) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells I Na 11 Estimated depth to high groundwater: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 2-23-04 Date ❑ Observed site(abutting propertylobservation hole within 150 fleet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) i ❑ Accessed USGS database -explain: I � I You must describe how you established the high ground water elevation: T.H. on Design plan 2-23-04 no G.W. at 11'. Bottom of chambers at 6'below grade_ Bottom of chambers at 5'above T.H. Depth. j j i i I I i i i Before filing this inspection Report,please see Report Completeness Checklist on next page. I t5in5.3113 Title 5 Offieal Inspection Form:Subsurface Sewage Dksposal System-Page 16 of 17 7 Jul 08 1510:55p p.17 Commonwealth of Massachusetts y Title 5 Official Inspection Form F >° Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road Property Address Dorothy Savarese Owner Owner's Name information is required for every Centerville MA 02632 7-7-15 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i f I i r I I i I i i I I j t I i t+f� 45ins•3J13 Title 5 Oflicia;Inspection Form.Subsurface Sewage Disposal System•Pape 17 of 17 f i 1 ; i Commonwealth of Massachusetts y Title 5 Official Inspection Form 00'- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road, Centerville _ Property Address Shaun Breau_ c/o Attorney Stephen Grande III Owner Owner's Name information is ry 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23 2009 required for every —p— , page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. - filling out forms Important:When A. General Information —' on the computer, COPY use only the tab 1. Inspectof: key to move your cursor-do not Troy Williams use the return key. Name of Inspector Troy Williams Septic Inspections Company Name 19 Hummel Drive _ Company Address South Dennis MA 02660 City/Town State Zip Code (508) 385-1300 S1682 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)..The system: ® Passes ❑ Conditionally.Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 23, 2009 Inspector's Signat a Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection, If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that,time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Dis osal System:Page 1 or 15 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments <'< 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is required for every 60 Union Avenue, Suite 1, Sudbury Q MA 01776 September 23, 2009 - __ _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Mass DEP at the time of inspection only. This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes or components. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old" or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: N/A . ❑ Observation of sewage backup or break out or high,static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 24 Meadow Farm Road,Centerville•03108 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 2 of 15 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments M 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is P required for every 60 Union Avenue, Suite 1, SudburyMA 01776- September 23, 2009 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh u r. 2. System will fail unless the Board of Health (and Public Water Supplier, if an determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary, to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tan k and SAS and the SAS is within 50 feet of a private water supply well. 24 Meadow Farm Road,Centerville 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 i Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments wM 24 Meadow Farm Road, Centerville _ Property Address Shaun Breau c/o Attorney_Stephen Grande III Owner Owner's Name information is 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23, 2009 required for every _ Y —�_ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: N/A `*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be . attached to this form. 3. Other: N/A D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No".to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ElStatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow Required pumping more than 4 times in the last year NOT due to.clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Meadow Farm Road, Centerville _ Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is p required for every 60 Union Avenue, Suite 1, SudburyMA 01776 September 23, 2009 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone.1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0009pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department: 24 Meadow Farm Road,Centerville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M s` 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande Ill Owner Owner's Name information is p required for every 60 Union Avenue, Suite 1, SudburyMA 01776 September 23 2009 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs.of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System.(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distanm,e.is unacceptable) [310 CMR 15.302(5)] 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III _ Owner Owner's Name information is 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23, 2009 required for every _ P _ page. Citylrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No . Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use?. . ❑ Yes ® No Water meter readings, if available last 2 ears usage d 08=79,000gals 9 ( Y 9 (gpd)): 07=134,000gals Sump pump? ❑ Yes ® No Last date of occupancy: Vacant approx. 4 to 6 months. Commercial/Industrial Flow Conditions: Type of Establishment; N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ® No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: N/A _ Last date of.occupancy/use: NIA Date Other(describe): . N/A _ 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is P required for every 60 Union Avenue, Suite 1, SudburyMA 01776 September 23, 2009 _ page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: No pumping info is available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons w w i N/A Ho as quantity pumped determined. q YP P Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Tank,d-box& leaching were installed on 5/12/04 per commence. Were sewage odors detected when arriving at the site? ❑ Yes ® No 24 Meadow Farm Road,,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Meadow Farm Road, Centerville _ Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is Y required for every 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23, 2009 --- —� page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 18"+ Depth below grade: feet----- --- Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): — Distance from private water supply well or suction liner N/A feet Comments (on condition of joints, venting, evidence of leakage, etc.): Lines were found clear at the time of inspection. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: N/A - years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 6'X 10.5'X 6' 1500 gallon 4� I Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 2' 8 Thin Layer Scum thickness. - 611 Distance from top of scum to top of outlet tee or baffle - — 14, Distance from bottom of scum to bottom of outlet tee or baffle — How were dimensions determined? Probe Measured 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 . Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow_Farm Road, Centerville_ Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owners Name information is 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23, 2009 required for every � _— _ _ _ P _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tee's were present. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A — Scum thickness N/A Distance from top of scum to.top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A _ Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P P P ) ( P ) Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A 24.Meadow Farm Road,Centerville•.03IU8 - - Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is 60 Union Avenue, Suite 1, Sudbury MA 01776 September 23, 2009 required for every -- _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: N/A Capacity: N/A gallons N/A Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A -- Alarm in working order:. ❑ Yes ❑ No Date of last pumping: N/A Date Comments (condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required).is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Level with Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found clean, level and in working order with equal distibution to outlet lines through speed levelers.. Pump Chamber(locate on site plan): Pumps in working order. , ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No i 24 Meadow Farm Road,Centerville:03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 15 r. Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w ' 24 Meadow Farm Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III _ Owner Owner's Name information is rY 60 Union Avenue, Suite 1, Sudbury MA 01776 Se tember 23, 2009 required for every -_-__ - -p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A _ Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: N/A Type: ❑ leaching pits number: ® leaching chambers number: 4 -500 gallon w/4' stone ❑ leaching galleries number: 13'X42'X2' ❑ . leaching trenches number, length: -- ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology. Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Chambers were dry on inspection with no evidence of hydraulic failure or problems in the past found at the time of inspection. 24 Meadow Farm Road,Centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 24 Meadow Farm Road, Centerville Property Address -_---- -'--- --- - -- --^ Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name information is ry — P required for every 60 Union Avenue, Suite 1, Sudbu MA 01776 September 23, 2009 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A------------------ ---- — Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A 24 Meadow Farm Road,Centerville•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Z. . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 Meadow Farm Road, Centerville _ Property Address Shaun Breau c/o Attorney Stephen Grande III Owner Owner's Name _ ---------------------- ------------------------------------------ information is f f 60 Union Avenue, Suite 1, Sudbu _MA. 01776 September 23 2009 required for every �__ _ _ _� __ page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ��y�✓ •.. I ' I- - PtTf 0 f O 24 Meadow Farm Road,Can •03/08 13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 J + Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w � 24 Meadow Farm_Road, Centerville Property Address Shaun Breau c/o Attorney Stephen Grande III_ _ Owner Owner's Name information is 60 Union Avenue, Suite 1, Sudbu MA 01776 September 23, 2009 required for every ram__ _ p page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® 'Check cellar ❑ Shallow wells _ Estimated depth to high ground water: 20.0' +feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record 7/11/00 If checked, date of design plan reviewed. Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Engineer letter on file ❑ Checked with local excavators, installers- attach documentation ® Accessed USGS database -explain: MIW 29 _Zone D_ 87 5.0' adjustment You must describe how you established the high ground water elevation: Soil was sandy. Test hole 6.5' below bottom of leaching with no water found at 11.0'. Groundwater adjustment in area at the time of inspection was 5.0'. Bottom of leaching at 4.5'was found not to be located in the high groundwater elevation at the time.of inspection. Also engineers letter is on file showing_system„was installed to plan and in compliance 24 Meadow Farm Road,Centerville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 i 1 Weller & Associates Bayberry Square — Suite 4C 1645 Falmouth Rd. --- P.O.Box 417 Centerville, MA 02632-0417 Date: May 8, 2006 Barnstable Health Department Barnstable Town Hall 200Main Street Hyannis, MA 02601 Re: Seminara Construction Corp., 4lMeadow Farm Rd., Centerville,Assessors Map.189,Parcel 118-7. Dear Health Dept.: Please be advised that we have inspected the soil removal and replacement, along with the installation of the septic system, at the above referenced property, and find that it was done in substantial compliance with the approved plan. If you have any questions, please do not hesitate to.contact us. Very truly yours, %A of"144 Daniel E. Bra NIEL E BRAMAN U) r s�otbA� t Fax: (508)775-0754 Phone(508)775-0735 i s �� 6 '? 13 05/17/2006 21:18 5083852605 SEMINARA CONSTRUCTIO PAGE 02/02 05/10/2006 09:58 5087750754 WELLER ASSOC , PAGE 01 Weller & Associates Bayberry Square — Suite 4C 1645 Falmouth Rd. -- P.O.Box 417 Centerville,MA 02632-0417 Date: May 8,2006 _Ile Barnstable Health Department Barnstable Town Hall 200Main Street Hyannis MA 02601 Re: Seminara Construction Corp.;24 Meadow Farm Rd.,Centerville,Assessors Map 1.89, Parcel 118-7. Dear Health Dept.: t.:p Please be advised that we have inspected the soil removal and replacement,along with the installation of the septic system, at the above referenced property,and find that it was done in substantial compliance with the approved plan. If you have any qucstions, please do not hesitate to contact us. Very truly yours, � J Daniel E.Braman, MAL Fax: (508)775-0754 Phone(508)775-0735 TOWN OF BARNSTABLE N LOCATION 04 Me ow ra4- t /ZJ- SEWAGE # VILLAGE Gd er1ler it i l le ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.M,6. Nc 7'n4eure— 5-08-38s-g40'j SEPTIC TANK CAPACITY 1`700 6a-1. oGa , So LEACHING FACILITY: (type) �rucve6/S (size) i 3`X Q Z ' X Z ' NO. OF BEDROOMS 5 BUILDER OR OWNER 6&A41 Y3!52-4-4-- 430n54 ' PERMIT DATE: 6- 30 '-0 1 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ��� Feet Private Water Supply Well and Leaching Facility (If any wells exist N A on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) N A Feet Furnished by (14. 0- (.CcJ-n"4�re, 2_ OV!/ to 3- 33,6 to 4; 18.6 5=44`(a 4 -45 �y � s � i P - No. . FEB..... ............. ...... �, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O TOWN OF BARNSTABLE liratiun for Dig uu%tl Ri urk,5 witr�� � nrttun runfit Applicatio s hereby made for Permit to Construct ( ' or Repair ( ) an Individual Sewage Disposal System at: �6 F 02 7 Location-Address --. r Lot No. alter Address `!�1 !/ UType of Building Size Lot_,4/Y-Q.....Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures .. W Design Flow.......... l/;;�.............. ... gallons per person per day. Total daily flow-------5 _---_-----------...gallons. R: Septic Tank—Liquid ca acit, alIons Len th-_// W P q P` g � g �---------- Width- -�------- Diameter---------------- Depth..�f'-----im.� x Disposal Trench— No. .--.l..............Width./- .-.--_-... Total Length-.>/ -•----.-- Total leaching Seepage Pit No...................... Diameter.........--......... Depth below inlet.................... Total leaching area._..-.-.._-___--sq. ft. Z Other Distribution box ( .�— Dosing tank ( ) Percolation Test Results Performed y------------------ Date2_"'��_•. . . ....................... Test Pit No. 1- 'z,._..minutes per inch Depth of Test Pit.CZ...... Depth to ground waterR,S:??t .... LL, Test Pit No. 2.��..minutes per inch Depth of Test Pit.--.-...�'-.--____. Depth to ground water.........`'............ ---------------------------------------------- Description of Soil------------c�� „ ...-._�J. �? -••-----------••------------ ----------_----•----- x /_ U w U -------•----------------------------•-------------••----------------------•-- ---------------...--------------------------------•------------------------------•-------......-•--••••........----•-.... tj Nature of Repairs or Alterations—Answer when applicable................................................................................................ • --••••••------------------------•-•--••--------••-•------------•-•••--•••••••-••---.....••-•.--•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the �! system in operation until a Certificate of Com e as b e issued by tIje 'd o� 3 Ve — L( Signe -------- - ---------- Application,Approved By - -- - -- - ----- -- ---- -- ------ -- .. ..... .. --- ---- --------- .: ------ -- ----- . Dace Application Disapproved for the following reaso s ----------------------------------------------------------------------------*----------------- ---------............ .. ......... - - ............ .mow are Permit No. ...... ..... ...... ..... .... Issued �.� Dace ._---------- ———————————————————— ---------_._____ ---._.—_ THE COMMONWEALTH OF MASSACHUSETTS f—V, BOARD OF HEALTH / TOWN OF BARNSTABLE Certificate of Compliance II T CE TIF t e n vi 1 Sewa isp Sy em c t ucted ) or Repaired ( ) by .... ...... ................... .. . �.... .: .......° 1----------------------- �� " �vl at ....../ .. - :1° �PKa+--------- �'`� - ----- -- -----.( >� -: - - - --........ Est has been installed in accordance with the provisions of TITI. 5 f e S ronmental Co e as described in the application for Disposal Works Construction Permit No. '".. dated __.. JJ THE ISSUANCE OF THIS CERTIFICATE SHALL NO E C NS U A7AS A GUAR NTfE THAT THE SYSTEM WILL / 2 F4hIJ4IOT S TISFACTORY. DATE. - ..... .- ---- ----------- _---------- Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Tomplianve THIS IS TO CERTIFY,.That the Individual Sewage Disposal,System constructed ( ) or Repaired ( ) by 1 ] —��� (^t"��� - fi t% . - -- - ----- ---y,� 1�,c�; . 1 r Y l 1 C at d has been installed in accordance with the provisions of TITLE 5 of The Sta.te,Environmental Code as described in the application for Disposal Works Construction Permit No.s r'�/ �'""_ _ .. dated Wa - .......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA/AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....... ................. .......... .._..._..-......--...---- ----.... Inspector .._....-�;v- `._------------- --------- ----—_--___---r --------- -_------------------------ ------------------- ——— •— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ; 1 TOWN OF BARNSTABLE No.:_!... ' .......... FEE..:<.................... Permission is hereby granted... t ► 1. _A--r. -, t_N _ � If1 c=......_ `�-', to Construct (/-)-or Repair (. ) an Individual Sewage.Disposal.System �� � r; at No------- ' 1 -'-'--- _'' ! ►!i l'-. ; )l`i �.t L.... ------------------------------------- t , .�. r t Strcet as shown on the application for Disposal Works Construction Permit No............i". Dated........................................... •--------------------------•----•-- t r� Board of Health DATE - ......................................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS No-----` ----------- FEB r _ r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appli 'atinu for Dit niul nrks C,nuntrurtinu lirrutit Applications hereby made for a Permit to Construct ((,r)' or Repair ( ) an Individual Sewage Disposal System at: _ f Location-Address G or Lot No. -----,�� Address- - (�/;r- �.,� Installer •--- ----• -•-- � Address ' UType of Building �.,. Size Lot..-� `~ 4 ....Sq. feet �-, Dwelling—No. of Bedrooms--------------.....-------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons-----------•---------------- Showers ( ) — Cafeteria ( ) P4 Other fixtures . Selig Tank—Liquid ...•.... ...' __.gallons per person per day. Total daily flow-------`5'?��"�....................gallons. Design Flow------------- d capacity �galIons Length---�/__..---- Width_.,_'-_..-.. Diameter.---.._..-._..- Depth-_�.!....... W x Disposal Trench—No. .....!............ Width_, _3.......... Total Length.. 5/�......... Total leaching area.. Seepage Pit No..................... Diameter...............----- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) I. Percolation Test Results Performed by.---�'!<.- .! �•!.-__G ' `.............. %2a _... Date.<..----------•-••.......... ........... Test Pit No. 1 e5;�--_-minutes per inch Depth of Test Pit-,/_ ...... Depth to ground water. :� ?...,.+ ... �Tq Test Pit No. 2.A55;;�' :..minutes per inch Depth of Test Pit--------- - Depth to ground water....-_------_---. -.-.-. 9.........................................................•---....-••--.........-•-•-•............---......................................................... Description of Soil -�' -•fir ` "' •--•---------------------- U •---------••----•...............•---...------•-•--•---•--------•--------•---•---••---------•-•--•-------••---------•---------------•- W UNature-of Repairs or Alterations—Answer when applicable............... ................................................................................ ................................................................•..•-------------•-.-•--•-------......._---.•---•-.•----•-----------......------........_....................--------........_........-- Agreement: r The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee.-issued by the board of health +� Signed �... -.. i- .... .......... ........ .. Application,Approved BY �'4 � /-.:.. 1�1 G G/f1a �' . !` ;..�y r Die.. fEi' V ✓ v jf ----- �.--r-..t. ....... Date" Application Disapproved for the following reasons:. ................................. . ..............:...........~..-....... ...... ...................... ............................... ... .. PermitNo. .X, "..:,......... ..._.....-..5.;...... ! .....-- Issued .............� ......-.:............... Date / I own oI Barnstable I, u Depsu•Inlent of Ileslllh,Safe(y, and rnvirounlenlnl Services 11C11111 Division Date _ �► 367 h4ah1 Slrccl,I lymmis MA 02601 u�nxarame j �J 16J9.plfoµ" ` Date Scheduled �� Time 3HFPM fee Pd. �1 Soil S?tbi itp Assessment fog' Se► afire Disposal I'elfonned Ily: Witnessed by: L�(7GA'1'l0N & G1,N* tAL IN1T0ftM-A`TIdN I.ocnlion Address Lorr 2 , N2A(�1"VV\11 Owner's Name' 1_E2 �.� L pvt.L.C-2 FARMS I�EI��Ty --I-�usT MS CE►-JTE(LVlLL6 .6A-R�IsrA 616 MA Address , -- Assessor's Ainp/Pnrccl: �;bpzrlw aF 18°0I 0.0-1 lalgiilccr,..sNnolc DDWt4W6 gwoi06'E(LIt�S6 NEW CONSTRUCTION REPAIR I'ekphnne ll (SOg) 3`a 'y S�}I Land Use \/ACArIT Slopcs(%) ©-s- Sorfnce Stones Dislnnccs lion': Open Wnler body 11 Possible Wct Area — fl Drinking Water Well ft Drainnge Way 11 Ihopuly Line SKI TCH it Other — fl S ICETC 11: (Street mmic,dlnlcosloos of lol,cxncl Incnlions of ICS1 holes k pert Icsts,locac wclimlds in proximity to holes) _ LI o.6 3 7�I 2- 00 =, 7141 ,oZ Ac. BASEMENT tr 1'1 � M ls� N � \ 31g,3s, F—D T 4 ` I'arenl nnnlcrinl(geologic) LAGI AL 0t1TWA5H Dcplh to bedrock 2 0 0 I)cpih to Groundwater: Standing Walcr in I lolc:_ N/A 1Vccping from i'il Fnce - lislinnalcd Scnsonal Iligh Qroondsvnlct NIA No UN-D pL'I'r1Z1YlINA:, I I�(— SEASONAL IiIGti:�'VA`I' lt.'�'AI3LL �dctlmd llsed: .. . . Depth Observed slalding in obs.hole: _CIA in. Depth to soil mollles: Depth to weeping from side of obs.hole: hl. Groundwater Adjaslnnernt Molex 1Vcll// _ .. Rrtndln(•Unlc: _ _ hldcx%Vcll Icvcl __ _ All fnclor Adj.Oroundwoter Level N/q _ I'CL2,C4�L;A'I'10N '['LS'I' '` ` :`:ti�ile � 'i•►ule 3�4SP,�l �� Observnfioo I lule It TN 1 TI+2 Time of 9" Dcplh of I'm L06 rt _ Time at 6" . Simi 11rc-sunk Timc rr :00 0!00 Tinlc(9"-6") Ind 1'rc-sunkcAd ay V i(nlcMin./bleb L� Z— In ols- Inas Site Suilnbilily Assessment: Site Passed Sill:failed: Addilional Tesiiog Needed(YIN) Original: Public IIcalth Division 0 Ilse l'1'll(loll Itole Dnln To Ile Completed on Macs( j Copy: Applicorll ` Pelvill fifilo Soil i10117,011 Soll-Fe�(fllrc Soil Color soil Other OolanilL DEEP OBSERVATION 1101AP Hole 11 DCplil limll Soil I lolizoll Soil]exillic Soil Unlor Suit (filter Soil I forizoll st)il,l,cxllllc Soil Color Soil | ` � � ' ' � ^ ljl4ALI � Ahovc]oo year/kmJbwooJmy H\/ Yo_�_ . wimh5oo year kmwJ, r wv xs____ ` x'NJo kmpcn,flood hvv",hry wv Ym___� ' M| � Does it |ovs( Fool. fee( n[xn(omI|yn:6,1mhnA } ill exist ill ,Uxnoxo��r"o| Umx/0|xm� U/o nmx pn4macJ K//(|msoil nbxondkx/ xyo{oxY |[oo(. v|m< ix life dq`U/ n[on{xmUyoxux/io8 |`orvimnmoicrix|Y --- ' CudD—C-11bm ` | cn1i[yUm( oil N"J (dn(o) | |mvo |mooJU`o Soil ovohm'orcxomiox(inorNxovoJhy ||/r |)npxdmno( n[Bwipnmnooin| Ppn|rdx U iom�Jm/ (|o m n6ovnm!ysix °ox |`or[ononJ |`yolocmo N ix|ov ni � (lie /cqxinx| (mio|o por bo oJ riCx JuxoihoJ ill 3 10CN|( 15.017. --h~+— � ' '' ^ W r i in U XXA FOUNDATION PLAN � N w � 3 0 f P arwernoruwrn'e---3 IL — I — — _ ' Ell Ll f I 19'-0' iL• 11:81/2' 90' I I6:3,/2" -0" - 5-0' 9-0' S-0' 5-0" 4"0' 90" B'�3946' �P-ii 15f16• � `� G A � Fill m ss ae- ,z aaramv es•cse•:to onewav ao5er/ fouaauurrorawtnurf•s Comm,uuy Cam rari• 5fORA(Z PMA s'v, � saN mI M!OMa0.•D.G G101D�611DM RDR aN•O.G G[P D�ffLIW I �� .n PAM W2 K'Y� L-- SO"%XY'Xq"paplO I \ �o-xy XIO"Paw Stst19FAN M}x% J (OlI6'rrE Y(OWMNPR)5 ��— N= t yCa= -- I Srm HLW 4:i1114" 3'-9' 12b' �.� PM5 I- Of ID't 10'1V2-VASE RN7` F r I'. Q z I 3o"Xio•Xla'PaeM] fl srtaIL wtrcauM>c CLO, roe 1�/4"X91/?"wl'S G1KREfE tN.tY LOIUMNpMS � 8 . IP44WLWlD CbY�)HfT'f f $ 4 1 WNb/OELOW.k$7"� 1 --1-- - - - - -- - - - - - 1 N 1 11 1z (2>Ij/Y'%91/T'lVL'SOV& - IFM OF WALL I P 9:6" 1N° 0 ILowpo — i I I fm p/ MEGl1ANm ROAM I — — — V I : I II I°a1 4 VATf OF -.- - - " FIN&155M - - - - - - - - - - - - - - - - - - - - - - - T�\- -- 2/27/04 > 5CA 6 UWE55 WTV, OfMRM5E — 1/4° 1' " 32W" r _ µ r r r ' 7 U � N 6B'1Y O9'-7 3N' 16'-311r C 4-1°' 4'-93M• -1112' 1f-0' 4'-43F4' 4�6' t 21rZ 90' 4'-111/2' -r6I41 U 101 CK � E RHP1GA51E.51 41/2"5RDPo°8f 4 - 35 5/8" a v- WPLK IN - — — — Ci OSef I ms 5"OOM 6==ml �x S� 'I MWALkVff2X* OED KtrOtN- MA5fM MM00M [� ,pro OR�AKfASf s � � �9 nnrca�n�art ftA fV - 17 3/4" e-101/4" 171/4" 2'- > 3' 3/4- y g C S 26M b"fAWMNS m 5 ® . �. MASTER HALLWAY ROOM — — — — _ — — — — — o e b' 9ATN APO NHI.LWAY � 43' Y3' 3'-9" 5'0' z-0' I If---Iw�iLimiorr T°0B°�iov e- 1 O. aaSwWo acro ow.rtooru�w 1 I V aerocn. 4o c I � �l/ Q oakf aFM9 a�oM N I raN a aaxr a aTAf ROOM p ry�� IiN QOM \/ 7d.. r I I g P4 O mumoom § N a4ro �LAIMI7RY � zerowanvrtnorcenx, I I g, � cp a�wvave�a�um�ianm 4 FOYER 0"�wus 2 � t � I e/urtonnarwuxwalsi � ;� � yi v. z I N MNG ROO s r®, n `O 1 9000 5 § \ / N CAR CAARAa I 9'E' 4'-0' 4'-/14 3-P 3:1' 4'-II• _ N 4"M25M COMM�.ImN T$' 16 i 4C1MW/9NCOMM wtw'o3F COVED PORCH 4 -TrO O O 11.1 SfCR 40EM1 17-6' 19-6• � C I" 6 A 1� cQo I I I I c2/15/4"%1n"�n's I m � 38172" � rarewac�eewralz VA2 OF FINAL I5 2/2-1/04 ^ � � � 6'6" I5-0' IO'-6' 3'.91/H' 7IH' '-07/0' 4'.I f/B• ��//''����CC jj��,,y�GG /%.M lUE5 NOTV OTFER % 1ST FLOOR PLAN 5 vQN9 t IE r N- Q- N Q N r a,o -Q o &lOG•151FM 94" 13-1w 3H• 6'-09N' f3'+9 f2" 73/4 +16" l µ-0• 4'.4 3M' S-0' TWO,�9650• o Poor W4 vemooM#4 BATH #Z --.- -_— _____ N � r v. A 6"cLNI uWar 4WD k *—•-- 3�2 n ® W S S •ro 2 � � H rq� II _•. — — — HIOk'� � $1� ® CMNG SYSIPM /,�,f � O i 1'y 3 u1 VI41tl f� a P 111G�����J po r MOW N .. ' o SAtN#IwarwWALK IN z — 3 — If - - - -l�F1A�A - - - - - - - =_ — _ �— ® fl 1 1 �7-912' 4E 12' 05 AMA 15 A 5WLP II 1 mtvooM#3 1 (I uov N pFw9w� 11� I I s e• § 6 A eH,2 1 N I Arne MVM I I AM eAM PINN 155[!1 2/L I/V"7 19'-8112' 7-13/h' �' 9'-it73N• 2T-1J IM' S'-512' 5C&f UNLE55 tM17 nE 2ND FLOOR PLAN 1/4" Nor TO sGALE 7Ee I �CLE L-08 Fly F b FIRST PIPE L.ENeTI1 V LAYER OF!t/a"FL.n5f9NE Z TOP rGts 7tiTIGN COVERS TO WVIrF1IN OVER S/a"-I I/2"DOL1l3t1: DATE TO r .E' IEVEL_ WASHED sroNE : ✓vc Y% �o�.a '- 99� b" cr FINISFit D 6RAPE rOR MIN. 2 .. t' rIN" 6wv� WFNE55: j Q Q , � � io Q 1 :, PERG RATE: fi.., c✓.' 2 ti" PVGAe d o " a" PV(1 rG'P n EL 3).`© 0 42.o z? 41.o n �} Ltr _ Lam vS 5!ZS rl u� SGr1 ao 3�.oa+� " y C r '3,yT' , 'Grp \ 3 , ao , � ' varrCM 0 EL o a Z 41.8 v) 5 , �� � u,�r,v�«„enrrn�a �Z.G 9, A G, 5 N cC1 p 6Nl.1�1 li 5Et°AznrloN G L5 f f z Sye 6rar- 8 39. n f; cep72S -�rl&J.D ��''�•)i/-,/ova• .�5-' ,�,upc-�,veca...►� ,�1�4T .r'.9 c DD5I ON DATA zN �a �1-72 S,0 PA LY FLOW: (j5) t5EDROOMS x 1 h&PD= gm LcArt1`sAura � �i hf. .53'c. U>D Ioyr-c.j8 ,fig,z I o 715 SEF 7",,TANK:5::5a&PD 400%=//006PD ': •n ,T"e5r'.135�: M, o'��* U5E:/500eALLON PRECAST 5EP1"L TANK �, .5 LEA6H i FAG I L IrY: 2.Sy���, USE: 6� :5-'x a. s , - GA'AGITY: z•SYc�3 � 751 /51DEWA_.L_: -.�,/'C> X' Z X d. -- G z;� 132�' ,�".�n OENERAL NO TOTAL vle(rK, }ca�1*' ,p r l GONTRAGTOR TO f3F RESPONS�I_.E FOR T 11E LOGATI9NOF ALL UT-Lff E5, , APOVE AND UNDER PR OR TO ANY t"XGAVATON OR GONSTRUGTON. '7a �Xt r, Z. SEPT[�SYSTEM TO pE NSTALLFP N GOMPLANGE wrH 3�2 GMR PDO'TfrLE V j '.,(� � /fJ � � / r '� -_ , /` „� yr. _ ._ _.. ''. ..,..,.. �,;,,A t\i k 1.'.,!??"._•T�/?F ycr;F��.f=:"7c C`>CJ t f">!"-•--r'Y` r....�ir.. r-,t�'T`�' c rs.`1-r n,.-i _. (! .4. ALL AREAS TO I3E LOAMED A P SEEDED 5. CON' A670F,TO PROVDE U HOUR NOTICE FOR ANY RE U RED NSPEGTbNs - ©- . '�e��/ �-- y' , �. `�, .3i��� � , ,,,� / fir} � • " ITE eENAaff- PLAN .. LOGAT I GN:_Z�-;�-/'c-,�S►.G�rc.J r�.�.�.z�� c ,,,,�.r�rr���c-- 36AL.E: PRAWN �,Y: F. A_ UVIL � NLM5ER: PAT 05. _1?/zb�e- sI-IEEr• 0A No. �_us Cf / Z 3 Zop . • � � 'wff S10"a� � k`��SIQMAL �,A-v� ��L_...L .�� � F�3 A�3�506, I A� 2 _ 1645 FALMOU f l RD �ITE 46 GENTERVILLE, MA O? ,-n TEL : 505 175--0735 ti FAX: (508) 775--0754 PROFESSIONAL ENGINEERS & LAND SURVEYORS